Challenges in Primary Care Health Systems

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Questions and Answers

What is the main benefit of standing orders and protocols in healthcare?

They streamline care and ensure quality care. (correct)

They complicate the treatment of non-complicated health issues.

They require all decisions to be made by physicians only.

They limit the roles of non-clinician team members.

How is physician salary structured to promote better care?

Salary is based solely on the number of patients seen.

Salaries depend on patient satisfaction surveys.

Compensation is linked to value, not just volume. (correct)

Physicians receive bonuses for patient referrals.

Which group of physicians reported higher levels of stress and burnout since COVID-19?

Physicians who work part-time hours.

Older physicians considering retirement.

Physicians working in specialty care.

Younger physicians entering primary care. (correct)

What trend is observed in the usage of primary care compared to specialty care?

Primary care usage is decreasing. Signup and view all the answers

What major challenge do primary care physicians face in relation to Electronic Health Records (EHR)?

EHRs can be time-consuming and interfere with patient care. Signup and view all the answers

How do multidisciplinary teams impact the challenges faced in primary care?

They can help overcome challenges in primary care. Signup and view all the answers

What primary issue do international medical graduates (IMGs) face in the healthcare system?

They encounter bias and discrimination as practitioners. Signup and view all the answers

What is 'desktop medicine' as mentioned in the context of EHR usage?

It indicates a style of practicing medicine primarily through digital platforms. Signup and view all the answers

Which of the following is NOT considered a primary care practitioner?

Cardiologist Signup and view all the answers

What is a significant issue related to the distribution of primary care practitioners?

Primary care access worsens in rural/lower income areas Signup and view all the answers

What primarily drives the geographical distribution of primary care providers?

Income levels of residents Signup and view all the answers

Which factor is mentioned as NOT influencing specialty choices among medical school graduates?

Income levels Signup and view all the answers

Which statement about international medical graduates (IMGs) in primary care is correct?

Proportionally, more IMGs work as PCPs than US graduates Signup and view all the answers

What trend is observed in the practice of primary care?

Rapid practice consolidation driven by payment models Signup and view all the answers

What contributes to healthcare disparities in primary care access?

Distribution of practitioners in low-income areas Signup and view all the answers

Which of the following statements regarding primary care providers is true?

Approximately 43% of physicians in the US are PCPs Signup and view all the answers

What is one of the primary strategies for cost reduction in prescription drug management?

Step therapy suggests trying cheaper drugs before more expensive options. Signup and view all the answers

How do rebates paid by manufacturers affect health insurance plans?

They maintain favorable formulary positions for manufacturers. Signup and view all the answers

What key factor determines the cost-sharing structure in value-based benefit design?

The perceived value of the drug rather than its price. Signup and view all the answers

What is a potential consequence of increased consolidation among PBM companies?

Higher manufacturer prices due to reduced competition. Signup and view all the answers

What significant financial impact would the IRA have had on Medicare in 2023 if negotiated prices were implemented?

It would result in savings of $6 billion. Signup and view all the answers

What was a characteristic of hospitals in the 1800s?

They functioned as municipal almshouses for social welfare. Signup and view all the answers

What role do pharmacy benefit managers (PBMs) play in drug pricing strategies?

PBMs leverage negotiating power to establish affordable pharmacies. Signup and view all the answers

Which factor is NOT typically considered to make healthcare more affordable?

Long research and development processes for new drugs. Signup and view all the answers

What is a key characteristic of adult foster homes?

They provide personal care services and room & board. Signup and view all the answers

What significant change did the 1987 Omnibus Budget Reconciliation Act introduce to nursing homes?

It established minimum standards and resident rights in nursing homes. Signup and view all the answers

What services are commonly provided by home health services?

Nursing, rehab, and therapy. Signup and view all the answers

Which of the following best describes the fastest growing segment of long-term care?

Adult day care. Signup and view all the answers

What unique aspect of the Meals on Wheels program is emphasized in its service?

It provides meals but also promotes social interactions. Signup and view all the answers

What is the projected trend regarding the older population with disabilities by 2040?

It is projected to double. Signup and view all the answers

Which factor is primarily highlighted as a major issue in long-term care funding?

Low percentage of older adults receiving Medicaid. Signup and view all the answers

What is the primary focus of resident-centered care in nursing homes?

Prioritizing resident autonomy and decision-making. Signup and view all the answers

How does Harrison et al. (2021) describe the approach to improve vaccine uptake?

Engaging community leaders and relatable figures. Signup and view all the answers

What is identified as a critical issue regarding staffing models in long-term care?

Poor staffing and reimbursement falling below care costs. Signup and view all the answers

What does the concept of 'double jeopardy' in age and intersectionality suggest?

Women face more severe consequences of aging than men. Signup and view all the answers

What distinguishes long-term care from acute care services?

Long-term care focuses on maintaining quality of life. Signup and view all the answers

What percentage of people reaching age 65 are expected to need long-term care?

70%. Signup and view all the answers

Study Notes

Standing Orders

Standing orders and protocols streamline healthcare and improve quality of care.
Non-clinician team members can treat uncomplicated health issues by using these orders.

Balanced Compensation

Physician salary is linked to value, not just the volume of patients seen.

Primary Care Crisis

Many physicians reported an increase in their workload since the start of COVID-19.
Younger physicians were more likely to experience stress and burnout.
Many older physicians are planning to retire soon which will leave the workforce with younger, more stressed and burned-out physicians.

International Medical Graduates

The role of International Medical Graduates (IMGs) is critical to address the physician workforce shortage.
Despite their contributions, IMGs face discrimination and bias from patients.
Restrictive US immigration policies limit opportunities for IMGs.

Quality of Life for Primary Care Physicians

Primary care physicians often experience an imbalance between effort and reward.
This imbalance is particularly evident when compared to specialty care physicians.
Primary care usage frequency is decreasing compared to specialty care.
Primary care physicians are increasingly working in teams with other healthcare professionals.

Electronic Health Records

For many physicians, using Electronic Health Records (EHRs) significantly worsened their professional satisfaction.
Some sources of dissatisfaction include:
- Time-consuming data entry
- Interference with in-person patient care
- Inability to exchange information between different EHR systems.

Desktop Medicine

Doctors spend a significant amount of time performing "desktop medicine" tasks, such as using EHRs.

Primary Care Practitioners (PCPs)

Examples of PCPs include:
- Family physicians
- General internists
- Geriatricians
- General pediatricians
- Nurse practitioners
- Physician assistants
Other members of a healthcare team can also contribute to primary care, such as nurses, pharmacists, health educators and medical assistants.
PCPs are concentrated more heavily in urban areas than rural areas.

Primary Care Shortage

The US is experiencing a growing shortage of PCPs.
Only 43% of US physicians are PCPs.
Primary care access tends to be worse in rural and lower-income areas, contributing to health and healthcare disparities.
The geographical distribution of providers is driven by income differences in various regions.
Specialty choices among medical school graduates are not primarily driven by income, but rather by personality fit and the content of the specialty.

Physician Education Debt

While medical school debt is a factor, a primary care career remains financially viable for graduates with median levels of education debt.

International Medical Graduates and Primary Care

A proportionally higher number of IMGs work as PCPs compared to US medical school graduates.
IMGs are often positioned to negotiate and manage affordable pharmacy networks in underserved areas with PCP shortages.

Cost Reduction Strategies for Primary Care

Strategies to reduce costs include:
- Encouraging the use of generics and affordable brand-name medications.
- Negotiating rebates from manufacturers and discounts from drugstores.
- Step therapy: Prescribing a cheaper drug before moving to a more expensive option.
- Prior authorization: Requiring pre-approval for certain medications.
- Indication restriction: Limiting the use of medications to specific conditions.

Rebates

Rebates are paid by drug manufacturers to health insurance plans via Pharmacy Benefit Managers (PBMs).
Manufacturers offer rebates in exchange for preferred formulary positions and exclusive contracts.
Rebates are only prevalent in competitive drug classes where multiple options exist.
Transparency issues related to rebates are present: It is unclear if insurer-level rebate savings are passed on to patients.
Consolidation of PBM companies can increase rebates and fees from manufacturers, leading to a vicious cycle of higher drug prices.

Insurer Price Control Methods

Insurers utilize methods to manage prescription drug costs, such as:
- Prior authorization
- Disease management: Improving outcomes, potentially reducing costs
- Value-based benefit design: Cost sharing determined based on drug value, not just price.

Prescription Drugs and the Inflation Reduction Act (IRA)

The IRA allows the government to negotiate drug prices for some top-selling medications covered by Medicare.
Implementation of negotiated prices in 2023 would have saved Medicare $6 billion.

Factors Contributing to High Drug Costs

Factors driving up prescription drug costs include:
- Biologics and other specialty drugs
- Consolidation of PBM companies
- Extensive research and development process
- High profit margins for drug manufacturers.

Factors Contributing to Lower Drug Costs

Factors that contribute to lower prescription drug costs include:
- Basing drug pricing and cost sharing on the drug's value.
- PBMs leveraging their negotiating power to establish affordable pharmacy networks and encourage generic use.
- Insurers implementing prior authorization and step therapy strategies.
- Direct negotiations with drug manufacturers (IRA).

Hospitals: Facts

Hospital-based care accounts for nearly one-third of all healthcare expenditures in the US.
The number of hospitals is decreasing.
Healthcare is the largest employer in the US.

Evolution of Hospitals

In the 1800s, hospitals were primarily "primitive institutions of social welfare" that served as municipal almshouses.
The population of older individuals with disabilities is projected to double by 2040, presenting challenges for healthcare resources.
The focus of nursing homes has shifted towards resident-centered care, prioritizing autonomy, consistent staffing, and a more home-like atmosphere.
Vaccine uptake is a social enterprise that requires concise and trustworthy information from trusted sources, such as community leaders.

Age and Intersectionality

Age is a social construction with stereotypes affecting power and inclusion.
Multiple forms of inequality often intersect, leading to "double or multiple jeopardy."
Ageism reinforces negative perceptions of aging.

Long-Term Care and Long-Term Support Services

Long-term care (LTC) services provide health-related support to maintain or improve function and quality of life over extended periods.
LTC is distinct from other medical or acute care, focused on maintenance rather than prevention, diagnosis, or treatment of disease.
LTC is not limited to older adults, as children with disabilities, adults under 65 with disabilities, and individuals with mental health disorders can also benefit from such services.
About 70% of those reaching age 65 will require LTC.

Types of LTC and Support Services

Types of long-term care and support services include:
- Adult Day Care: Supports individuals with functional or cognitive impairment during the day.
- Adult Foster Homes: Provide personal care and living accommodations to residents.
- Home Health Services: Offer nursing, rehabilitation, and therapy for homebound individuals requiring assistance with daily living.
- Home Delivered Meals: Provide meal assistance for individuals who are unable to prepare meals for themselves.
- Nursing Homes: Provide care for individuals with long-term needs who cannot be properly supported at home.

Nursing Homes

Nursing homes house individuals who require long-term care beyond what can be provided at home.
Nursing homes can be funded privately or through Medicaid.
Challenges facing nursing homes include chronic understaffing, high staff turnover, and insufficient reimbursement rates.
The Nursing Home Reform Act of 1987 mandated significant improvements in resident quality of life, care standards, and protection from abuse.
Nursing homes are moving away from being "mini-hospitals" towards a more resident-centered care approach.

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Description

This quiz explores various issues affecting primary care physicians, including the impact of standing orders, compensation based on value, and the ongoing crisis exacerbated by COVID-19. It also highlights the critical role of International Medical Graduates and the quality of life challenges they face in the healthcare system.